ch. 69 patient w/ diabetes questions

All of the following are complications of diabetes except? - Infection, retinopathy - Peripheral neuropathy, pregnancy complications - Autonomic neuropathy, psychosocial - Nephropathy, silent killer - Amputation, muscular dystrophy

- Amputation, muscular dystrophy

Type 1 diabetes - No insulin production, exogenous insulin required - Insulin levels, normal, elevated, or low; exogenous insulin needed by some

- No insulin production, exogenous insulin required

Which of the following is not true or oral findings that may occur with diabetes? - Periodontitis is more frequent, severe, and longer duration - Increased risk of caries related to decreased saliva - Lips are dry, cracking, and angular cheilitis - Saliva is increased, with diminished taste perception - Hypogeusia occurs

- Saliva is increased, with diminished taste perception

Type 1 diabetes - Young - Older

- Young

Healthy, well controlled HbA1c levels...

<6%

Uncontrolled HbA1c levels...

>8%

Uncontrolled diabetes contributes to the severity of periodontal infection. A periodontal infection can complicate the control of blood glucose levels in diabetics. A) Both statements are true. B) Both statements are false. C) The first statement is true and the second statement is false. D) The first statement is false and the second statement is true.

A) Both statements are true.

Your patient with diabetes has gone into insulin shock. What is the first step in addressing this emergency? A) Give the patient glucose. B) Give the patient insulin. C) Call 911. D) Recline the patient and monitor vital signs.

A) Give the patient glucose.

A patient is taking sulfonylureas to control type 2 diabetes. What potential diabetic emergency should you watch for during dental treatment? A) Hypoglycemia B) Hyperglycemia C) Ketoacidosis D) Hyperapnea

A) Hypoglycemia

Patients with uncontrolled glucose levels are at higher risk for periodontal disease. Routine dental procedures including deep scaling procedures can be completed when the uncontrolled diabetic has received antibiotic premedication. A) The first statement is true and the second statement is false. B) The first statement is false and the second statement is true. C) Both statements are true. D) Both statements are false.

A) The first statement is true and the second statement is false.

Case Study 1 Susan Fones is a 34-year-old teacher who comes in every 6 months for her cleaning. She was diagnosed with diabetes as a child and gives herself an insulin shot daily. She is concerned about her bleeding gums and has noticed mobility of her lower anterior teeth. She reports an extremely dry mouth and a burning tongue. She has taken her insulin today at 6:00 AM and indicates that its peak action occurs between 2 and 3 hours after the injection. Open and read the attached case to answer the following question. The patient has what type of diabetes? A) Type 1 B) Type 2 C) Juvenile diabetes D) Gestational diabetes

A) Type 1

Case Study 1 Susan Fones is a 34-year-old teacher who comes in every 6 months for her cleaning. She was diagnosed with diabetes as a child and gives herself an insulin shot daily. She is concerned about her bleeding gums and has noticed mobility of her lower anterior teeth. She reports an extremely dry mouth and a burning tongue. She has taken her insulin today at 6:00 AM and indicates that its peak action occurs between 2 and 3 hours after the injection. Open and read the attached case to answer the following question. The presence of xerostomia is most likely caused by: A) medication. B) diet. C) allergic reaction. D) renal function.

A) medication.

When treating a patient with diabetes, one should do all of the following except: A) schedule appointments before a meal. B) consult with the treating physician. C) limit the length of appointment. D) be prepared for a diabetic-related emergency.

A) schedule appointments before a meal.

Peripheral neuropathy in diabetics may result in loss of sensation in the:

hands

The 15/15 Rule is used to treat:

hypoglycemia.

Type 2 diabetes: in children the typical age at diagnosis is >____ years of age. A) 6 B) 8 C) 10 D) 12

C) 10

Systematic reviews suggest patients with diabetes are at _____ times greater risk for more severe periodontal disease than individuals without diabetes. A) 1 to 2 B) 2 to 3 C) 2 to 4 D) 2 to 6

C) 2 to 4

Which of the following is not a symptom of hypoglycemia? A) Headache B) Dizziness C) Hunger D) Dry hot skin

D) Dry hot skin

Patients with diabetes mellitus type 1: A) have increased insulin in the blood. B) have non-insulin-dependent diabetes. C) can control insulin level through proper diet. D) have decreased insulin production by the pancreas.

D) have decreased insulin production by the pancreas.

All of the following are possible complications of diabetes except: A) increased susceptibility to infection. B) increased risk for cardiovascular disease. C) increased risk for kidney dysfunction. D) increased rate of blood disorders.

D) increased rate of blood disorders.

A patient has an acetonic, fruity smelling breath. This is a classic symptom of: A) insulin shock. B) hypoglycemia. C) glucose intolerance. D) ketoacidosis.

D) ketoacidosis.

True or False, Periodontal infections do not affect control of blood glucose levels.

False

__________________ diabetic coma, too little insulin, accumulation of ketone bodies in the blood.

Ketoacidosis

Diabetic coma/Ketoacidosis - Too much insulin - Too little insulin

Too little insulin

Hypoglycemia/Insulin Shock... in regards to amount of insulin present

Too much insulin

Case Study 2 Susan Fones is a 34-year-old teacher who comes in every 6 months for her cleaning. She was diagnosed with diabetes as a child and gives herself an insulin shot daily. She is concerned about her bleeding gums and has noticed mobility of her lower anterior teeth. She reports an extremely dry mouth and a burning tongue. She has taken her insulin today at 6:00 AM and indicates that its peak action occurs between 2 and 3 hours after the injection. Open and read the attached case to answer the following question. Which of the following etiologic factors is related to the development of this type of diabetes? A) Insulin resistance B) Autoimmune destruction of beta cells C) Hormone imbalance D) High carbohydrate intake

B) Autoimmune destruction of beta cells

Which one of the following viruses are associated with destruction of beta cells? A) Coxsackie B) Mumps C) Chicken pox D) Rotavirus

B) Mumps

Insulin is produced in which body organ? A) Stomach B) Pancreas C) Liver D) Intestines

B) Pancreas

Case Study 2 Susan Fones is a 34-year-old teacher who comes in every 6 months for her cleaning. She was diagnosed with diabetes as a child and gives herself an insulin shot daily. She is concerned about her bleeding gums and has noticed mobility of her lower anterior teeth. She reports an extremely dry mouth and a burning tongue. She has taken her insulin today at 6:00 AM and indicates that its peak action occurs between 2 and 3 hours after the injection. Open and read the attached case to answer the following question. The peak action of Susan's insulin is reached between 2 and 3 hours. This range of action indicates the insulin is what classification? A) Rapid acting B) Short acting C) Intermediate acting D) Long acting

B) Short acting

All of the following factors impact the need for insulin except: A) food intake. B) alcohol intake. C) infection. D) variations in exercise.

B) alcohol intake.

Polydipsia is: A) excessive hunger. B) excessive thirst. C) excessive urination. D) none of the above.

B) excessive thirst.

The most common type of dental emergency associated with a person having diabetes is: A) hyperapnea. B) hypoglycemia. C) hyperglycemia. D) ketoacidosis.

B) hypoglycemia.

T/F Diabetes that is under metabolic control is not a contraindication for implant placement and osseointegration can occur. Patients with diabetes appear to have an impaired bone healing response to implant placement.

Both True

Case Study 2 Susan Fones is a 34-year-old teacher who comes in every 6 months for her cleaning. She was diagnosed with diabetes as a child and gives herself an insulin shot daily. She is concerned about her bleeding gums and has noticed mobility of her lower anterior teeth. She reports an extremely dry mouth and a burning tongue. She has taken her insulin today at 6:00 AM and indicates that its peak action occurs between 2 and 3 hours after the injection. Open and read the attached case to answer the following question. Susan's dental appointment should be scheduled during early morning to ensure that she is treated soon after a full meal. The ideal time for the appointment when considering her insulin intake is during the peak time of her insulin dosage. A) The first statement is true and the second statement is false. B) The first statement is false and the second statement is true. C) Both statements are true. D) Both statements are false.

C) Both statements are true.

Which of the following oral manifestations is common in persons who are diabetic? A) Increased salivary flow B) Whitish patches on oral mucosa C) Candidiasis D) Petechia on the hard palate

C) Candidiasis

Which of the following is true concerning extra/intraoral findings associated with diabetes? A) Oral cancer B) Lichen planus C) Hypogeusia D) A and B E) B and C F) A and C G) All the above

C) Hypogeusia (or E) B and C)

Insulin directly or indirectly affects every organ in the body. Well-controlled diabetes is a contraindication to placement of a dental implant. A) Both statements are true. B) Both statements are false. C) The first statement is true and the second statement is false. D) The first statement is false and the second statement is true.

C) The first statement is true and the second statement is false.

All of the following are clinical manifestations of hyperglycemia except: A) polyuria. B) polydipsia. C) polyarthritis. D) polyphagia.

C) polyarthritis.

True or False, Diabetes does not increase the risk for periodontal disease.

false

True or False, Gestational diabetes, have a tendency to develop type 1 diabetes later in life.

false

True or False, In general, the patient with well controlled diabetes is treated the same as the patient without diabetes and requires premedication.

false

True or False, Treat patients on a full stomach. A patient who eats lunch at 12 does have a full stomach at 3 PM.

false

True or False, Type 1 diabetes former names were non-insulin dependent diabetes mellitus, adult onset diabetes, maturity onset diabetes, and/or ketosis resistant diabetes.

false

True or False, Without insulin, glucose accumulates in the blood, resulting in hyperglycemia. Normal blood glucose levels in healthy individuals usually range from 800-1000 mg/dl.

false

T/F Diabetes Mellitus is a group of metabolic diseases associated with hyperglycemia (High blood glucose)

true

T/F Evidence indicates individuals with diabetes had more severe periodontal disease and a higher A1c than healthy individuals.

true

T/F Gestational diabetes is when pregnant women get diabetes during pregnancy. More than 50% of women with GDM go on to develop type 2 diabetes within 5-10 years.

true

T/F Hyperglycemic Reaction also known as diabetic coma (ketoacidosis). Too little insulin (hypoinsulinemia) with increased levels of blood glucose (hyperglycemia).

true

T/F Hypoglycemia is also known as insulin shock. It is too much insulin (hyperinsulinemia), which lowers the level of blood glucose (hypoglycemia). Hypoglycemia is low blood glucose and it is an emergency in the dental setting that can occur.

true

T/F Insulin is a hormone produced by beta cells in the pancreas.

true

T/F Normal blood glucose levels in healthy individuals range form 60-99 mg/dL, and the hemoglobin A1C is less than 5.6%.

true

T/F Patients with diabetes have increased periodontal disease in teeth involved endodontically and have a reduced likelihood of success of root canal treatment.

true

T/F Systematic reviews suggest patients with diabetes are at a two to four times greater risk for more severe periodontal disease than individuals without diabetes.

true

T/F The most frequent medication used to manage blood glucose level is metformin.

true

T/F Type 1 diabetes mellitus accounts for 5-10% of those with diabetes. Typically arises in childhood or adolescence.

true

T/F Type 2 diabetes mellitus is most prevalent type of diabetes accounting for 90-95% of all patients with diabetes. Onset typically occurs in adulthood.

true

True or False, Diabetes does not cause oral disease but may lower resistance and increase susceptibility to the oral findings.

true

True or False, Gestational diabetes, infants are larger; premature births are more frequent; the incidence of congenital malformations and perinatal death is higher.

true

True or False, Insulin can be administered through an inhalation.

true

True or False, Poorly controlled periodontal health may alter blood glucose levels.

true

True or False, Treatment of periodontal infection and reduction of periodontal inflammation is associated with improved glycemic control through a reduction in level of glycosylated hemoglobin (H bA1c).

true

True or False, Type 1 diabetes symptoms include polyuria, polydipsia, and polyphagia.

true